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Huang J, Qiao X, Song K, Liu R, Huang S, He J, Zhu S, Reinhardt JD, He C. Effectiveness of Rehabilitation Interventions in Individuals With Emerging Virtual Respiratory Tract Infectious Disease: A Systematic Review and Meta-Analysis. Clin Rehabil 2024; 38:857-883. [PMID: 38629433 DOI: 10.1177/02692155241239881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
OBJECTIVE Assessing rehabilitation effectiveness for persistent symptoms post-infection with emerging viral respiratory diseases. DATA SOURCES Systematic review of seven databases (MEDLINE, EMBASE, Cochrane Library, PEDro, MedRxiv, CNKI, Wanfang) until 30 December 2023. REVIEW METHODS Evaluated 101 studies (9593 participants) on respiratory function, exercise capacity, and quality of life. Methodological quality was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized controlled trials (RCTs), the Newcastle-Ottawa Scale (NOS) for observational studies and non-RCTs, and the NIH Quality Assessment Tools for before-after studies. RESULTS The most common rehabilitation program combined breathing exercises with aerobic exercise or strength training. Rehabilitation interventions significantly enhanced respiratory function, as evidenced by improvements on the Borg Scale (MD, -1.85; 95% CI, -3.00 to -0.70, low certainty), the mMRC Dyspnea Scale (MD, -0.45; 95% CI, -0.72 to -0.18, low certainty), and the Multidimensional Dyspnoea-12 Scale (MD, -4.64; 95% CI, -6.54 to -2.74, moderate certainty). Exercise capacity also improved, demonstrated by results from the Six-Minute Walk Test (MD, 38.18; 95% CI, 25.33-51.03, moderate certainty) and the Sit-to-Stand Test (MD, 3.04; 95% CI, 1.07-5.01, low certainty). CONCLUSION Rehabilitation interventions are promising for survivors of viral respiratory diseases, yet gaps in research remain. Future investigations should focus on personalizing rehabilitation efforts, utilizing remote technology-assisted programs, improving research quality, and identifying specific subgroups for customized rehabilitation strategies to achieve the best outcomes for survivors.
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Affiliation(s)
- Jinming Huang
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xu Qiao
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Kangping Song
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rong Liu
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shuangshuang Huang
- Rehabilitation Medicine Department, The Fifth People's Hospital of Sichuan Province, Chengdu, China
| | - Jing He
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Siyi Zhu
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jan D Reinhardt
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Center for Rehabilitation Research, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Chengqi He
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Pleguezuelos E, Del Carmen A, Moreno E, Serra-Prat M, Serra-Payá N, Garnacho-Castaño MV. Telerehabilitation improves cardiorespiratory and muscular fitness and body composition in older people with post-COVID-19 syndrome. J Cachexia Sarcopenia Muscle 2024. [PMID: 38937986 DOI: 10.1002/jcsm.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/26/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The effects of post-coronavirus disease 2019 (COVID-19) syndrome on the cardiorespiratory and muscular fitness in older people are of utmost relevance. This study aimed to evaluate the effects of a 12-week telerehabilitation programme on cardiorespiratory and muscular fitness and body composition in older patients with post-COVID-19 syndrome. METHODS One hundred twenty older patients with post-COVID-19 syndrome were randomly assigned to one of two groups: patients who carried out the telerehabilitation programme (n = 60; age: 65.0 ± 5.2; female: 14.2%) and a control group (n = 60; age: 64.3 ± 5.0; female: 24.5%). An incremental cardiopulmonary exercise testing, isokinetic strength test, and bioelectrical impedance analysis were performed to compare cardiorespiratory and muscle strength responses and body composition between telerehabilitation and control groups. RESULTS A significant increase in the cardiopulmonary exercise testing duration was found in the telerehabilitation group compared to the control group (mean difference = 88.9 s, P = 0.001). Peak oxygen uptake increased in the telerehabilitation group (mean difference = 3.0 mL·kg-1·min-1, P < 0.001) and control group (mean difference = 1.9 mL·kg-1·min-1, P < 0.001). Power output in cycle ergometer (mean difference = 25.9 watts, P < 0.001), fat free mass (mean difference = 2.1 kg, P = 0.004), soft lean mass (mean difference = 2.1 kg, P = 0.003), and skeletal muscle mass (mean difference = 1.4 kg, P = 0.003) only increased in the telerehabilitation group. A significant increase in the power output was observed in the telerehabilitation group compared with the control group in both lower limbs after isokinetic strength test of the leg extension at a speed of 60° (right: mean difference = 18.7 watts, P = 0.012; left: mean difference = 15.3 watts, P = 0.010). The peak torque of right leg extension increased only in the telerehabilitation group after isokinetic strength test at a speed of 60° (mean difference = 13.1 N·m, P < 0.001). A significant increase in the power output was observed in the telerehabilitation group compared with the control group in the left leg extension after isokinetic strength test at a speed of 180° (mean difference = 30.2 watts, P = 0.003). CONCLUSIONS The telerehabilitation programme improved cardiorespiratory and muscular fitness, and body composition in older patients with post-COVID-19 syndrome to a greater extent than a control group. The telerehabilitation programmes may be an alternative to improve the sequelae of post-COVID-19 syndrome in older patients.
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Affiliation(s)
- Eulogio Pleguezuelos
- Department of Physical Medicine and Rehabilitation, Hospital of Mataro, Barcelona, Spain
- Department of Experimental Science and Healthcare. Faculty of Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Amin Del Carmen
- Department of Physical Medicine and Rehabilitation, Hospital of Mataro, Barcelona, Spain
| | - Eva Moreno
- Department of Physical Medicine and Rehabilitation, Hospitalet General Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Noemí Serra-Payá
- DAFNiS Research Group (Pain, Physical Activity, Nutrition and Health), Campus Docent Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Manuel Vicente Garnacho-Castaño
- DAFNiS Research Group (Pain, Physical Activity, Nutrition and Health), Campus Docent Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de Valencia (VIU), Valencia, Spain
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Nantakool S, Sa-nguanmoo P, Konghakote S, Chuatrakoon B. Effects of Exercise Rehabilitation on Cardiorespiratory Fitness in Long-COVID-19 Survivors: A Meta-Analysis. J Clin Med 2024; 13:3621. [PMID: 38930148 PMCID: PMC11204731 DOI: 10.3390/jcm13123621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Poor cardiorespiratory fitness poses the highest risk of mortality. Long-COVID-19 survivors exhibit a reduced cardiorespiratory fitness (CRF). While exercise rehabilitation, such as cardiopulmonary exercise, is used for long-COVID-19 survivors, the effects of exercise on CRF in this population remain inconclusive. In this study, we aim to systematically summarise and synthesise whether exercise rehabilitation improves CRF among long-COVID-19 survivors. Methods: A comprehensive search was performed through PubMed, CINAHL, Embase, Scopus, and the Cochrane Library (since their inception to November 2023) and study reference lists. Studies presenting the effects of exercise rehabilitation on CRF (peak oxygen consumption (VO2peak) and six-minute walk distance (6MWD)) in long-COVID-19 survivors were identified. The standardised mean difference (SMD), mean difference (MD), and 95% confidence interval (CI) were used for analyses. The certainty of evidence was measured using a Grading of Recommendation Assessment, Development and Evaluation approach. Results: Twelve eligible studies (five RCTs and seven non-RCTs) with 682 participants were analysed. The meta-analysis showed significantly improved 6MWDs (MD 76.47, 95% CI 59.19-93.71, low certainty) and significantly greater 6MWDs (SMD 0.85, 95% CI 0.11-1.59, very low certainty) in the exercise rehabilitation group compared to the control group. A significantly improved 6MWD was found in subgroups of young to middle-aged adults and subgroups of patients who undertook aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. Conclusions: Exercise rehabilitation is effective for improving CRF, as measured by the 6MWD in long-COVID-19 survivors. Improvements are likely to be more pronounced in specific subgroups of young to middle-aged adults and patients undertaking aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. However, recommendations for clinical practice are limited due to the very low evidence certainty.
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Affiliation(s)
- Sothida Nantakool
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Piangkwan Sa-nguanmoo
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.-n.); (S.K.)
| | - Supatcha Konghakote
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.-n.); (S.K.)
| | - Busaba Chuatrakoon
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.-n.); (S.K.)
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Ortiz-Ortigosa L, Gálvez-Álvarez P, Viñolo-Gil MJ, Rodriguez-Huguet M, Góngora-Rodríguez J, Martín-Valero R. Effectiveness of pulmonary rehabilitation programmes and/or respiratory muscle training in patients with post-COVID conditions: a systematic review. Respir Res 2024; 25:248. [PMID: 38890699 PMCID: PMC11186160 DOI: 10.1186/s12931-024-02857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The term "post-COVID-19 condition" refers to the symptomatology that appears between four to twelve weeks after Covid-19 infection. These symptoms can persist for weeks or even months, significantly diminishing the quality of life for affected individuals. The primary objective of this study was to assess the effectiveness of pulmonary rehabilitation programs and/or respiratory muscle training on respiratory sequelae in patients with post-COVID condition. METHODS The literature search was conducted in the following databases: PubMed, PEDro, Embase, Cochrane, Scopus, and Web of Science. Randomized clinical trials were included in which participants were aged 18 years or older. Articles were excluded if at least one of the therapies did not involve pulmonary rehabilitation or respiratory muscle training, if the participants were COVID positive, if studies lacked results, and finally, if interventions were conducted without supervision or at home. This review only encompasses supervised non-virtual interventions. This study adheres to the PRISMA statement and has been registered in the PROSPERO database (CRD42023433843). RESULTS The outcomes obtained in the included studies are assessed across the following variables: Exercise capacity using the 6-minute walk test, Dyspnea, fatigue, Pulmonary function, Maximum inspiratory pressure, and Quality of life. CONCLUSION Despite the absence of a specific treatment at present, it was evident from this review that a well-structured pulmonary rehabilitation program that incorporates both aerobic and muscular strength exercises along with techniques and inspiratory muscle exercises was the most effective form of treatment.
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Affiliation(s)
- Lucía Ortiz-Ortigosa
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Málaga, 29071, Spain
| | - Paula Gálvez-Álvarez
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Málaga, 29071, Spain
| | | | | | | | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Málaga, 29071, Spain.
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Lai CY, Lin CH, Chao TC, Lin CH, Chang CC, Huang CY, Chiang SL. Effectiveness of a 12-week telerehabilitation training in people with long COVID: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101853. [PMID: 38824899 DOI: 10.1016/j.rehab.2024.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Telerehabilitation has been developed and applied for years for cardiac and pulmonary diseases with good clinical outcomes. However, its application to participants with long COVID remains limited. OBJECTIVES To investigate the effectiveness of a 12-week telerehabilitation training program in participants with long COVID. The primary outcome was cardiorespiratory fitness (CRF), and secondary outcomes were physical activity (PA) amounts, exercise self-efficacy, sleep quality, and health-related quality of life (HRQOL). METHODS A parallel-group, randomized controlled trial was conducted. Eligible participants with long COVID (n = 182) were randomly assigned in a 1:1 ratio to either the experimental group (EG) or the control group (CG). The EG received 12 weeks of telerehabilitation training with weekly remote monitoring for exercise maintenance and support. The CG received PA counseling only. CRF, PA amounts, exercise self-efficacy, sleep quality, and HRQOL were assessed at baseline and 12 weeks. Generalized estimating equations were used to analyze the intervention effects by examining the interaction between time and group. RESULTS One hundred twenty-two participants (67 %) completed the study, and 182 were included in the intention-to-treat analysis. The EG had greater walking behavior (β = -763.3, p < 0.001), total amount of PA (β= -711, p = 0.003), exercise self-efficacy (β = -1.19, p < 0.001), and better sleep quality (β = 1.69, p = 0.012) after the 12-weeks of telerehabilitation training than the CG. However, there were no significant differences in any CRF parameters or HRQOL at 12 weeks between the EG and CG. CONCLUSION Telerehabilitation training offers a personalized and convenient approach that can increase exercise willingness and PA amounts and improve sleep quality. These findings underscore the potential benefits of telerehabilitation training for promoting healthier lifestyles and improving overall health outcomes. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT05205460) on January 25, 2022.
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Affiliation(s)
- Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing & School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chueh-Ho Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
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Szarvas Z, Fekete M, Szollosi GJ, Kup K, Horvath R, Shimizu M, Tsuhiya F, Choi HE, Wu HT, Fazekas-Pongor V, Pete KN, Cserjesi R, Bakos R, Gobel O, Gyongyosi K, Pinter R, Kolozsvari D, Kovats Z, Yabluchanskiy A, Owens CD, Ungvari Z, Tarantini S, Horvath G, Muller V, Varga JT. Optimizing cardiopulmonary rehabilitation duration for long COVID patients: an exercise physiology monitoring approach. GeroScience 2024:10.1007/s11357-024-01179-z. [PMID: 38771423 DOI: 10.1007/s11357-024-01179-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group (n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021-31/DEC/2022, while an age-matched control group (n = 100) received a single check-up. To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05). Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption (p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome.
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Affiliation(s)
- Zsofia Szarvas
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Monika Fekete
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gergo Jozsef Szollosi
- Coordination Center for Research in Social Sciences, Faculty of Economics and Business, University of Debrecen, Debrecen, Hungary
| | - Katica Kup
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Rita Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Maya Shimizu
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Fuko Tsuhiya
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ha Eun Choi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Huang-Tzu Wu
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Nedda Pete
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Renata Cserjesi
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Regina Bakos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Orsolya Gobel
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Kata Gyongyosi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Renata Pinter
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Dora Kolozsvari
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kovats
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cameron D Owens
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoltan Ungvari
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stefano Tarantini
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gabor Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Muller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Janos Tamas Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
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Nasrullah A, Virk S, Javed A, Shah A, Ramanujam D, Sharma A, Gutierrez L, Nauer K, Maggio M, Yin Y, Bajwa Y, Cheema T, Disilvio B. Effects of pulmonary rehabilitation on functional and psychological parameters in post-acute sequelae of SARS-CoV-2 infection (PASC) patients. BMC Pulm Med 2024; 24:231. [PMID: 38745298 PMCID: PMC11092229 DOI: 10.1186/s12890-024-03047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND COVID-19 survivors may develop long-term symptoms of fatigue, dyspnea, mental health issues, and functional limitations: a condition termed post-acute sequelae of COVID-19 (PASC). Pulmonary rehabilitation (PR) is a recommended treatment for PASC; however, there is a lack of data regarding PR's effect on multiple health indices and the factors that influence patient outcomes. The aim of our study is to evaluate the impact of pulmonary rehabilitation on functional and psychological parameters in patients diagnosed with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), thereby offering insights into the efficacy of such interventions in improving the quality of life and clinical outcomes for these individuals. METHODS We extracted patient demographic, comorbidity, and outcome data from Allegheny Health Network's electronic medical records. Functionality test results were compared before and after PR, including 6-minute walk test (6MWT), chair rise repetitions (CR reps), timed up and go test (TUG), gait speed (Rehab gait), modified medical research council scale (MMRC), shortness of breath questionnaire (SOBQ), hospital anxiety and depression scale (HADS) and chronic obstructive pulmonary disease assessment test (CAT) scores. Multiple regression analysis was done to evaluate the effect of comorbidities and patient factors on patient responses to PR. RESULTS The 55 patients included in this study had a mean time of 4 months between the initial COVID-19 diagnosis and the subsequent PASC diagnosis. Following pulmonary rehabilitation (PR), significant improvements were observed across various metrics. The distance covered in the 6-minute walk test (6MWT) increased markedly from a pre-rehabilitation average of 895 feet (SD 290) to 1,300 feet (SD 335) post-rehabilitation, with a mean change of 405 feet (95% CI [333, 477]). Chair rise repetitions (CR reps) saw an increase from 9 (SD 3) reps to 13 (SD 3) reps, with a change of 4 reps (95% CI [3.7, 4.9]). The timed up and go test (TUG) time decreased significantly from 13 s (SD 5) to 10 s (SD 2), reflecting a mean reduction of 3 s (95% CI [-4.5, -2.5]). Rehabilitation gait speed improved from 1.0 m/s to 1.3 m/s, changing by 0.3 m/s (95% CI [0.2, 0.3]). The Modified Medical Research Council (MMRC) dyspnea scale showed a notable decrease from a mean of 2 (SD 1) to 1 (SD 1), a change of -1 (95% CI [-1.5, -1]). The Shortness of Breath Questionnaire (SOBQ) scores reduced significantly from 51 (SD 21) to 22 (SD 18), with a change of -29 (95% CI [-34, -23]). The Hospital Anxiety and Depression Scale (HADS) scores decreased from 11 (SD 7) to 8 (SD 7), a reduction of -4 (95% CI [-5, -2]). Lastly, the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) scores significantly dropped from 18 (SD 7) to 9 (SD 7), changing by -10 (95% CI [-11, -8]). However, the presence of hypertension, diabetes, chronic lung diseases, outpatient status, and receipt of specific pharmacologic treatments (decadron, decadron + remdesivir, and decadron + remdesivir + tocilizumab) were identified as factors associated with a poor response to PR. CONCLUSION Our study supports PR as an integrated model of care for PASC patients to improve several physical and mental health indices. The long-term effects of PR on patients' functional status should be investigated in the future.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Shiza Virk
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Anam Javed
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Aaisha Shah
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Deeksha Ramanujam
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Alisha Sharma
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Laura Gutierrez
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Kevin Nauer
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Yue Yin
- Allegheny-Singer Research Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Tariq Cheema
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
| | - Briana Disilvio
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
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Michalas M, Katsaras S, Spetsioti S, Spaggoulakis D, Antonoglou A, Asimakos A, Katsaounou P, Christakou A. The Effect of Physiotherapy on Dyspnea, Muscle Strength and Functional Status in Patients with Long COVID Syndrome. J Pers Med 2024; 14:515. [PMID: 38793097 PMCID: PMC11121916 DOI: 10.3390/jpm14050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Patients who were infected with COVID-19 may experience Long COVID syndrome. We examined the effectiveness of physiotherapy on dyspnea, muscle strength, and functional status in Long COVID syndrome. METHODS The exercise group underwent an 8-week supervised physiotherapeutic program consisting of interval aerobic exercise and strengthening exercises, each lasting 30 min. The control group did not engage in any exercise. Dyspnea, muscle strength, and functional status were assessed at the beginning and end of the intervention in both groups. RESULTS No significant baseline differences were found between the two groups. The exercise group demonstrated improvements compared to baseline in dyspnea, quadriceps muscle strength, and functional status. Specifically, there was a significant increase of 3.7 lifts in the 60-s sit-to-stand test (p = 0.01), an increase of 5.86 kg in right quadriceps muscle strength (p = 0.03), an increase of 8.26 kg in left quadriceps muscle strength (p = 0.01), and a decrease in dyspnea score by 0.95 points (p = 0.02). CONCLUSIONS Similar studies have reported improvements in dyspnea, muscle strength, and functional status in the exercise group. However, further research with larger sample sizes is needed to confirm these findings.
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Affiliation(s)
- Michail Michalas
- Department of Physiotherapy, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece; (M.M.); (S.K.)
| | - Stefanos Katsaras
- Department of Physiotherapy, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece; (M.M.); (S.K.)
| | - Stavroula Spetsioti
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Dimitrios Spaggoulakis
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Archontoula Antonoglou
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Andreas Asimakos
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Paraskevi Katsaounou
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Anna Christakou
- Department Physiotherapy, Lab Biomechanics, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece
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9
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Çelik Z, Kafa N, Güzel NA, Köktürk N. The effects of physical activity tele-counseling intervention on physical activity, functional performance, and quality of life in post-COVID-19 conditions: a randomized controlled trial. Expert Rev Respir Med 2024; 18:321-331. [PMID: 38829396 DOI: 10.1080/17476348.2024.2363862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND This study aims to investigate the effectiveness of tele-counseling to promote physical activity in COVID-19 survivors at the persistent phase. METHODS Twenty-eight participants who suffered from COVID-19 were randomly assigned to intervention and control groups. Physical activity counseling was applied according to the transtheoretical model to the intervention group during 20 sessions. Second assessments were performed 6 weeks after the intervention. The physical activity, functional performance (4-meter gait speed; 4-MGS and 5-repetition Sit-To-Stand; STS test), exercise behavioral change and processes, quality of life, fatigue, mental health, severity of symptoms, and dyspnea were evaluated in groups. RESULTS The baseline demographic and clinical outcomes were similar (p > 0.05) except for physical role limitations and general health perceptions in groups. Five-repetition STS, 4-MGS, activity dyspnea, step counts, sitting time, physical role limitations, Exercise Processes of Change Scale (EPCS) total, and behavioral processes scores except for self-liberation significantly improved in the counseling group. Five-repetition STS, 4-MGS improved while dramatic relief, self reevaluation, self-liberation, and EPCS total scores deteriorated in the control group. CONCLUSIONS The tele-counseling intervention contributes to improving physical activity, functional performance, behavioral change, quality of life, and decreasing common problems related to COVID-19. The results of the tele-counseling intervention are promising in post-COVID-19 conditions. TRIAL REGISTRATION (CLINICALTRIALS.GOV) Registration ID: NCT04853966.
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Affiliation(s)
- Zeliha Çelik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Nihan Kafa
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Nevin A Güzel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Nurdan Köktürk
- Department of Pulmonary Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
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10
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Gloeckl R, Zwick RH, Fürlinger U, Schneeberger T, Leitl D, Jarosch I, Behrends U, Scheibenbogen C, Koczulla AR. Practical Recommendations for Exercise Training in Patients with Long COVID with or without Post-exertional Malaise: A Best Practice Proposal. SPORTS MEDICINE - OPEN 2024; 10:47. [PMID: 38658496 PMCID: PMC11043268 DOI: 10.1186/s40798-024-00695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 04/26/2024]
Abstract
People with long COVID may suffer from a wide range of ongoing symptoms including fatigue, exertional dyspnea, reduced exercise performance, and others. In particular, impaired exercise performance is a condition that can be recovered in many people through an individualized physical exercise training program. However, clinical experience has shown that the presence of post-exertional malaise (PEM) is a significant barrier to physical exercise training in people with long COVID. Currently, there is no guideline or consensus available on how to apply exercise training in this cohort. Therefore, we conducted a literature review in the PubMed library using the following search terms: "COVID", "post-COVID", "long COVID" and "exercise" searching for studies from January 2020 to January 2024. Data from 46 trials were included. Exercise training regimes were very heterogeneous and none of these studies reported on the management of PEM in the context of an exercise training program. Based on the feedback from an additional survey that was answered by 14 international experts in the field of exercise training in long COVID, combined with the authors´ own extensive practical experience, a best practice proposal for exercise training recommendations has been developed. This proposal differentiates exercise procedures according to the presence of no, mild/moderate or severe PEM in people with long COVID. These recommendations may guide allied healthcare professionals worldwide in initiating and adjusting exercise training programs for people with long COVID, stratified according to the presence and severity of PEM.
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Affiliation(s)
- Rainer Gloeckl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Ralf H Zwick
- Therme Wien Med, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Ulrich Fürlinger
- Therme Wien Med, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Tessa Schneeberger
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Daniela Leitl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Uta Behrends
- Childrens' Hospital, School of Medicine, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Andreas Rembert Koczulla
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany.
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.
- Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria.
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11
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Zifko U, Guendling K, Seet R, Kasper S. Management of cognitive impairment associated with post-COVID-19 syndrome: recommendations for primary care. Front Pharmacol 2024; 15:1338235. [PMID: 38711990 PMCID: PMC11072190 DOI: 10.3389/fphar.2024.1338235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction: Although post-COVID-19 syndrome (PCS) with cognitive impairment is increasingly encountered in primary care, evidence-based recommendations for its appropriate management are lacking. Methods: A systematic literature search evaluating the diagnosis and treatment of cognitive impairment associated with PCS was conducted. Practical recommendations for the management of PCS-associated cognitive impairment in primary care are summarized, based on an evaluation of pharmacological plausibility and clinical applications. Results: Currently, the pathology of cognitive impairment associated with PCS remains unclear with no high-quality data to support targeted interventions. Existing treatment approaches are directed towards symptom relief where counseling on the chronicity of the disease and regular reassessments at 4- to 8-week intervals is considered reasonable. Patients should be informed and encouraged to adopt a healthy lifestyle that centers around balanced nutrition and appropriate physical activities. They may also benefit from the intake of vitamins, micronutrients, and probiotics. The administration of Ginkgo biloba extract could offer a safe and potentially beneficial treatment option. Other non-pharmacological measures include physiotherapy, digitally supported cognitive training, and, if indicated, ergotherapy or speech therapy. In most patients, symptoms improve within 8 weeks. If serious, ambiguous, or when new symptoms occur, specialized diagnostic measures such as comprehensive neurocognitive testing or neuroimaging should be initiated. Very few patients would require inpatient rehabilitation. Conclusion: PCS with cognitive impairment is a debilitating condition that could affect daily functioning and reduce work productivity. Management in primary care should adopt a multidisciplinary approach, centering around physical, cognitive, and pharmacological therapies.
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Affiliation(s)
- Udo Zifko
- Rudolfinerhaus private clinic GmbH, Rudolfinerhaus, Vienna, Austria
| | | | - Raymond Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siegfried Kasper
- Center for Brain Research, Department of Molecular Neuroscience, Medical University of Vienna, Vienna, Austria
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12
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Gaudreau-Majeau F, Gagnon C, Djedaa SC, Bérubé B, Malo J, Iglesies-Grau J, Gayda M, Bherer L, Besnier F. Cardiopulmonary rehabilitation's influence on cognitive functions, psychological state, and sleep quality in long COVID-19 patients: A randomized controlled trial. Neuropsychol Rehabil 2024:1-17. [PMID: 38607276 DOI: 10.1080/09602011.2024.2338613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/02/2024] [Indexed: 04/13/2024]
Abstract
CLINICALTRIALS.GOV NCT05035628.Trial registration: ClinicalTrials.gov identifier: NCT05035628..
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Affiliation(s)
- Flavie Gaudreau-Majeau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Christine Gagnon
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
| | - Sarah Clavet Djedaa
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Béatrice Bérubé
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Jacques Malo
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Josep Iglesies-Grau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Mathieu Gayda
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Louis Bherer
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - Florent Besnier
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
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Tesarz J, Lange H, Kirchner M, Görlach A, Eich W, Friederich HC. Efficacy of supervised immersive virtual reality-based training for the treatment of chronic fatigue in post-COVID syndrome: study protocol for a double-blind randomized controlled trial (IFATICO Trial). Trials 2024; 25:232. [PMID: 38570805 PMCID: PMC10993519 DOI: 10.1186/s13063-024-08032-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The treatment of persistent fatigue after COVID-19 infection is complex. On the one hand, it involves maintaining a sufficient level of physical and mental activity to counteract possible degenerative processes of the body and nervous system. On the other hand, physical and mental activities can also lead to worsening of symptoms. Therefore, the challenge in treating Post-COVID fatigue is to stimulate the body and central nervous system in a way that stimulates growth and improvement, but does not overtax individual physical and mental limits. Special training programs try to take these characteristics into account, but often reach their limits. A promising approach is offered by new fitness technologies based on immersive virtual realities that stimulate both body and brain while minimizing physical and psychological stress. The aim of this study is to investigate the efficacy of supervised immersive Virtual Reality (VR)-based activity training compared to conventional activity training for patients with Post-COVID-associated fatigue. METHODS In a single centre, individually randomised, prospective, double-blind two-arm exploratory superiority trial with parallel group design, N = 100 patients with persistent fatigue after COVID-19 infection will be recruited. The intervention includes a supervised immersive neuromuscular training (12 sessions of 30 min over 6 weeks) based on a novel VR-exercise device. We will systematically compare the effects of this intervention on Post-COVID-associated fatigue with a supervised conventional activation program of comparable scope without an immersive environment. The primary outcome is the difference between groups in absolute change in the mean fatigue symptom severity measured on the Fatigue Severity Scale (FSS) from baseline to posttreatment assessment. Posttreatment assessment in both groups will be conducted by blinded outcome assessors. At three and six months afterwards, patients are sent self-report questionnaires for follow up. The main analysis will be based on the intention-to-treat principle. DISCUSSION To the best of our knowledge, this is the first exploratory study on a supervised immersive neuromuscular training for the treatment of persistent fatigue after COVID-19 infection. TRIAL REGISTRATION German register for clinical studies (ID: DRKS00032059) Prospectively registered on June 16th 2023. URL of trial registration.
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Affiliation(s)
- Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany.
- DZPG (German Centre for Mental Health), Partner Site Heidelberg/ Mannheim/ Ulm, Heidelberg, Germany.
| | - Hannah Lange
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Axel Görlach
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
- DZPG (German Centre for Mental Health), Partner Site Heidelberg/ Mannheim/ Ulm, Heidelberg, Germany
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14
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Martínez-Pozas O, Meléndez-Oliva E, Rolando LM, Rico JAQ, Corbellini C, Sánchez Romero EA. The pulmonary rehabilitation effect on long covid-19 syndrome: A systematic review and meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2077. [PMID: 38389299 DOI: 10.1002/pri.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis aims to evaluate the efficacy of pulmonary rehabilitation (PR) in improving dyspnea, fatigue, physical activity, quality of life, anxiety and depression in patients with Long COVID-19 (LC). The impact of PR on LC and a comparison of face-to-face and telerehabilitation approaches was explored. METHODS This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. A literature search included PubMed, Web of Science, and Cochrane Library until January 2023. No language filters were applied. Randomized controlled trials, non-randomized controlled trials, and observational studies were included. The risk of bias was assessed using appropriate tools. Descriptive analysis and meta-analysis were performed. Forest plots presented results. Statistical analyses were conducted using the Metafor Package in R v.3.4.2. RESULTS/FINDINGS This systematic review and meta-analysis included 16 studies on PR in LC patients. A total of 1027 adults were included. The studies varied in design, with seven observational studies, three quasi-experimental studies, and six randomized controlled trials. Dyspnea, physical function, quality of life, psychological state, and fatigue were assessed as outcomes. The review found that pulmonary rehabilitation had a significant positive effect on dyspnea, physical function, quality of life (both global and physical domain), anxiety, and depression. However, the effect on fatigue was not significant. Heterogeneity was observed in some analyses, and publication bias was found in certain outcomes. Age and study design were identified as potential moderators. Both face-to-face and telerehabilitation interventions improved the studied outcomes, with only differences in the physical domain of quality of life favoring the face-to-face group. IMPLICATIONS ON PHYSIOTHERAPY PRACTICE PR improved dyspnea, physical function, quality of life, and psychological state in LC patients, but not fatigue. Face-to-face and telerehabilitation have similar effects, except for physical quality of life.
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Affiliation(s)
- Oliver Martínez-Pozas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
| | - Erika Meléndez-Oliva
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Valencia, Valencia, Spain
| | | | - José Antonio Quesada Rico
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Camilo Corbellini
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.S.B.L., Differdange, Luxembourg
| | - Eleuterio A Sánchez Romero
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
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Calvache-Mateo A, Reychler G, Heredia-Ciuró A, Martín-Núñez J, Ortiz-Rubio A, Navas-Otero A, Valenza MC. Respiratory training effects in Long COVID-19 patients: a systematic review and meta-analysis. Expert Rev Respir Med 2024; 18:207-217. [PMID: 38800959 DOI: 10.1080/17476348.2024.2358933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION To date, it is unknown whether respiratory training interventions can benefit Long COVID-19 patients. The main objective was to analyze the effects of respiratory training on patients with Long COVID-19, concretely on respiratory muscle strength, lung function, dyspnea, and functional capacity. METHODS We performed a systematic review following PRISMA statement using PubMed, Scopus, and PEDro (last search November 2023). The risk of bias was assessed using the Cochrane tool. We included randomized controlled trials testing the effect of respiratory training interventions in Long COVID-19 patients versus no intervention, control, or placebo intervention. The data was pooled, and a meta-analysis was complete. RESULTS We selected 7 studies, which included 572 patients. Meta-analysis results show significant differences in favor of respiratory training in respiratory muscle strength (MD = 13.71; 95% CI = 5.41; 22; p = 0.001), dyspnea (SDM = 1.39; 95% CI = 0.33; 2.46; p = 0.01) and functional capacity (SDM = 0.90; 95% CI = 0.37; 1.43; p = 0.0009), but not in lung function (MD = 0.28; 95%CI = -0.27; 0.83; p = 0.32). CONCLUSION The results of this systematic review with meta-analysis suggest that respiratory training improves respiratory muscle strength and functional capacity in Long COVID-19 patients, as well as dyspnea if combined with therapeutic exercise. However, respiratory training does not improve lung function in these patients. REVIEW REGISTRATION PROSPERO IDENTIFIER CRD42022371820.
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Affiliation(s)
- Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Bruxelles, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alba Navas-Otero
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Seo JW, Kim SE, Kim Y, Kim EJ, Kim T, Kim T, Lee SH, Lee E, Lee J, Seo YB, Jeong YH, Jung YH, Choi YJ, Song JY. Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID. Infect Chemother 2024; 56:122-157. [PMID: 38527781 PMCID: PMC10990882 DOI: 10.3947/ic.2024.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/27/2024] Open
Abstract
"Long COVID" is a term used to describe a condition when the symptoms and signs associated with coronavirus disease 2019 (COVID-19) persist for more than three months among patients infected with COVID-19; this condition has been reported globally and poses a serious public health issue. Long COVID can manifest in various forms, highlighting the need for appropriate evaluation and management by experts from various fields. However, due to the lack of clear clinical definitions, knowledge of pathophysiology, diagnostic methods, and treatment protocols, it is necessary to develop the best standard clinical guidelines based on the scientific evidence reported to date. We developed this clinical guideline for diagnosing and treating long COVID by analyzing the latest research data collected from the start of the COVID-19 pandemic until June 2023, along with the consensus of expert opinions. This guideline provides recommendations for diagnosis and treatment that can be applied in clinical practice, based on a total of 32 key questions related to patients with long COVID. The evaluation of patients with long COVID should be comprehensive, including medical history, physical examination, blood tests, imaging studies, and functional tests. To reduce the risk of developing long COVID, vaccination and antiviral treatment during the acute phase are recommended. This guideline will be revised when there is a reasonable need for updates based on the availability of new knowledge on the diagnosis and treatment of long COVID.
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Affiliation(s)
- Jun-Won Seo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Seong Eun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Jung Kim
- Health, Welfare, Family and Gender Equality Team, National Assembly Research Service, Seoul, Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, and Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Yu Jung Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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Bileviciute-Ljungar I, Norrefalk JR, Borg K. Improved Functioning and Activity According to the International Classification of Functioning and Disability after Multidisciplinary Telerehabilitation for Post-COVID-19 Condition-A Randomized Control Study. J Clin Med 2024; 13:970. [PMID: 38398284 PMCID: PMC10889504 DOI: 10.3390/jcm13040970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
This study investigates the outcomes and feasibility concerning the functioning and activity of multidisciplinary group telerehabilitation for a post-COVID-19 condition. Recruitment for the group rehabilitation was announced three times during 2021 and 2022 through the COVID-19 patient organization in Sweden. The key inclusion criteria were remaining symptoms and functional impairments beyond 12 weeks after SARS-CoV-2 infection; medical assessment and treatment regarding comorbidities or new postinfection symptoms; the ability to use the Internet. Participants were randomized into a rehabilitation group or onto a waiting list using an Internet program. Multiple outcomes included self-scored questionnaires and physical tests before and after eight weeks, and at six months follow-up. Here, we present the self-scored outcomes on the International Classification of Functioning and Disability questionnaire (ICF, 22 body functions and 16 activity/participation categories) and breathing scales. Of the 164 participants who registered for the study, 67 (mean age 43, 78% women) participated in an eight-week group rehabilitation compared to 42 who served as waiting list controls (mean age 47, 88% women). At six months follow-up, 60 participants from the rehabilitation group and 21 from the waiting list completed the data. The results indicate that a larger number of ICF body functions and activity/participation categories had improved in the rehabilitation group after eight weeks and six months. Overall credibility, as assessed by the Credibility Expectancy Questionnaire, was high, and the attrition rate in rehabilitation was low. The results indicate beneficial outcomes for multidisciplinary telerehabilitation in people suffering from a post-COVID-19 condition. Therefore, rehabilitation interventions should be further developed and implemented in clinical practice.
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Affiliation(s)
- Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, 18288 Stockholm, Sweden; (J.-R.N.); (K.B.)
- Multidisciplinary Pain Clinic, Capio St. Göran Hospital, 11219 Stockholm, Sweden
- Department of Physical and Rehabilitation Medicine, Danderyd University Hospital, 18288 Stockholm, Sweden
| | - Jan-Rickard Norrefalk
- Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, 18288 Stockholm, Sweden; (J.-R.N.); (K.B.)
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, 18288 Stockholm, Sweden; (J.-R.N.); (K.B.)
- Multidisciplinary Pain Clinic, Capio St. Göran Hospital, 11219 Stockholm, Sweden
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18
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Kerling A, Beyer S, Dirks M, Scharbau M, Hennemann AK, Dopfer-Jablonka A, Lampe V, Salzmann JHW, Tegtbur U, Drick N, Pink I, Haufe S. Effects of a randomized-controlled and online-supported physical activity intervention on exercise capacity, fatigue and health related quality of life in patients with post-COVID-19 syndrome. BMC Sports Sci Med Rehabil 2024; 16:33. [PMID: 38308307 PMCID: PMC10835885 DOI: 10.1186/s13102-024-00817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The Post-COVID-19 syndrome (PCS), which can occur after acute respiratory syndrome coronavirus 2 infection, leads to restrictions in everyday activity. Our study assessed the impact of an online-guided intervention which intended to facilitate physical activity on the mental and physical capability of PCS patients. METHODS We randomized 62 patients with PCS (20 male/ 42 female; age: 46 ± 12 years; body mass index: 28.7 ± 6.7 kg/m2) with a score ≥ 22 in the fatigue assessment scale (FAS) to a 3-month exercise-focused intervention (IG n = 30) or control period (CG n = 32). We assessed changes in exercise capacity (bicycle exercise test with measurements of gas exchange), fatigue, markers of health-related quality of life (HrQoL) and mental health. RESULTS The FAS score decreased significantly in both study groups (IG: 35.1 ± 7.4 to 31.8 ± 8.5 points; CG: 35.6 ± 7.4 to 32.6 ± 7.5 points, both p < 0.01). Exercise capacity did not increase in the CG or IG (within-group changes for IG: peak oxygen uptake: 0.9 ± 2.6 ml/min/kg, p = 0.098; peak power output: 6.1 ± 17.8 W, p = 0.076) with no significant changes in HrQoL and work ability. Patients with a FAS score at baseline ≥ 35 (severe fatigue) showed no change in exercise capacity with the 3-month intervention whereas the sub-group of patients with FAS < 35 points (moderate fatigue) showed improvements, independent of the study group. CONCLUSIONS Our 3-month intervention seems appropriate for patients with moderate fatigue, whereas those with more severe fatigue appear to be too restricted with respect to their mental or physical health status to perform exercise at a level which is sufficient to improve markers of physical performance. TRIAL REGISTRATION German Clinical Trials Register (registration trial number: DRKS00026245) on September 2 2021.
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Affiliation(s)
- Arno Kerling
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sebastian Beyer
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Meike Dirks
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Michèle Scharbau
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | | | - Viktoria Lampe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Uwe Tegtbur
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Isabell Pink
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Sven Haufe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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19
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Calvache-Mateo A, López-López L, Heredia-Ciuró A, Martín-Núñez J, Valenza-Peña G, Cabrera-Martos I, Valenza MC. Early Effects of a Pain-Informed Movement Program in Patients with Post-COVID-19 Condition Experiencing Persistent Pain: Protocol for a Randomized Controlled Trial. J Clin Med 2024; 13:597. [PMID: 38276103 PMCID: PMC10816970 DOI: 10.3390/jcm13020597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: The COVID-19 pandemic has generated 771 million confirmed cases. Of these patients, 60% have developed persistent symptoms including pain. This pain is a complex symptom that needs comprehensive therapeutic strategies to address it holistically. The main objective of this study will be to evaluate the early impact of the Pain Informed Movement (PIM) program in patients with post-COVID-19 conditions experiencing new-onset persistent pain. (2) Methods: A randomized, single-blind clinical trial will be performed. Patients will be randomly assigned (1:1) to the experimental or control group. The experimental group will undergo a PIM program consisting of low-intensity functional exercises, pain neuroscience education, and relaxation techniques. The control group will receive no intervention. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: This study will provide a basis for future research to support the implementation of comprehensive therapeutic approaches in the care of patients with post-COVID-19 persistent pain.
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Affiliation(s)
| | | | | | | | | | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (L.L.-L.); (A.H.-C.); (J.M.-N.); (G.V.-P.); (M.C.V.)
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20
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Weigl M, Beeck S, Kraft E, Stubbe HC, Adorjan K, Ruzicka M, Lemhöfer C. Multidisciplinary rehabilitation with a focus on physiotherapy in patients with Post Covid19 condition: an observational pilot study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01747-y. [PMID: 38231399 DOI: 10.1007/s00406-023-01747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
There is a lack of interventions that treat the Post-Covid-19 Condition (PCC) itself. Accordingly, treatment guidelines recommend physiotherapy interventions to alleviate symptoms and enhance functioning. In cases where unimodal treatments prove ineffective, non-organ-specific multidisciplinary bio-psycho-social rehabilitation (MBR) programs are a suitable option. In a pilot observational study with assessments at the entry and end of treatment we aimed to evaluate the feasibility of a 3-week day clinic MBR program and explore its effects on physical functioning in PCC patients with fatigue and reduced physical capacity. Patient selection was based on an interdisciplinary assessment involving a physician, a psychologist and a physiotherapist. Feasibility was determined based on full participation (≥ 8 of 9 days) and maintenance of stable endurance in the 6-Minute Walk Test (6MWT). From 37 patients included in the study, 33 completed the MBR (mean age: 43 ± 12 years, 73% female). Four patients discontinued the MBR, with two of them having reported deterioration of PCC symptoms. The 6MWT showed a numerical improvement from 501 ± 97 m to 512 ± 87 m, although it did not reach statistical significance. These results support the feasibility of outpatient MBR with a focus on active physiotherapy interventions in PCC patients with fatigue. This study aligns with previous research supporting the effectiveness of physiotherapy and rehabilitation in PCC patients. However, further research is needed to address possible different treatment responses and varying treatment approaches in subgroups of PCC patients.
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Affiliation(s)
- Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Physical and Rehabilitation Medicine, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Saskia Beeck
- Department of Orthopaedics and Trauma Surgery, Physical and Rehabilitation Medicine, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Physical and Rehabilitation Medicine, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Municipal Hospital Group, Munich, Germany
| | - Hans Christian Stubbe
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Kristina Adorjan
- Department of Medicine II, LMU University Hospital Munich, Munich, Germany
| | - Michael Ruzicka
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital, Jena, Germany
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21
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Wang WT, Chen IW, Hung KC. Inspiratory muscle training for COVID-19: Benefits appear promising but findings remain uncertain. J Med Virol 2024; 96:e29387. [PMID: 38235839 DOI: 10.1002/jmv.29387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Wei-Ting Wang
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan city, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
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22
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Zheng C, Chen XK, Sit CHP, Liang X, Li MH, Ma ACH, Wong SHS. Effect of Physical Exercise-Based Rehabilitation on Long COVID: A Systematic Review and Meta-analysis. Med Sci Sports Exerc 2024; 56:143-154. [PMID: 37586104 DOI: 10.1249/mss.0000000000003280] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
PURPOSE The number of persons living with post-coronavirus disease 2019 (COVID-19) conditions or long COVID continues to rise worldwide; however, the etiology and the treatment of long COVID remain nebulous. Therefore, efficient, feasible, and cost-effective therapeutic strategies for a large population with long COVID remain warranted. Physical exercise-based rehabilitation is a promising strategy for long COVID, although its therapeutic effects remain to be determined. This systematic review and meta-analysis aimed to examine the effects of physical exercise-based rehabilitation on long COVID. METHODS The electronic databases Medline, Embase, Global Health (Ovid), CINAHL (EBSCO), Web of Science, WHO Global Research Database on COVID-19, LitCovid, and Google Scholar were searched from their inception to November 2022. The identified articles were independently screened by three reviewers, and a random-effects model was used to determine the mean differences in the meta-analysis. RESULTS Twenty-three studies involving 1579 individuals who had COVID-19 (752 women) were included. Physical exercise-based rehabilitation showed beneficial effects on long COVID-related symptoms characterized by dyspnea, fatigue, and depression, as well as on the 6-min walk test, forced expiratory volume in 1 s/forced vital capacity, and quality of life in people who had COVID-19. CONCLUSIONS Physical exercise-based rehabilitation is a potential therapeutic strategy against long COVID and can be applied as a routine clinical practice in people who have recovered from COVID-19. However, customized physical exercise-based rehabilitation programs and their effects on specific types of long COVID require future large-scale studies.
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Affiliation(s)
| | | | - Cindy Hui-Ping Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
| | - Xiao Liang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
| | - Ming-Hui Li
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
| | - Alvin Chun-Hang Ma
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, CHINA
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
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23
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Morgan SP, Visovsky C, Thomas B, Klein AB. Respiratory Muscle Strength Training in Patients Post-COVID-19: A Systematic Review. Clin Nurs Res 2024; 33:60-69. [PMID: 37902108 DOI: 10.1177/10547738231201994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Estimates of 10-49% of patients may experience ongoing symptoms after COVID-19, including dyspnea. Respiratory muscle strength training has been used to reduce dyspnea in other respiratory diseases, thus, it may be a viable option for individuals with post-COVID-19 symptoms. The objective of this review was to evaluate the evidence for the effectiveness of respiratory muscle strength training for individuals with post-COVID-19 dyspnea. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, Web of Science, PubMed, EMBASE, Google Scholar, and Scopus databases were searched from 2020-2023. Eleven articles met the inclusion criteria. Pulmonary measures were improved in all but one study, and dyspnea, physical capacity and quality of life measures achieved statistical significance. Outcomes improved following respiratory muscle strength training as a standalone intervention, or with aerobic and peripheral muscle strength training.
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Affiliation(s)
| | | | - Bini Thomas
- School of Physical Therapy and Rehabilitation, University of South Florida, Tampa, USA
| | - Aimee B Klein
- School of Physical Therapy and Rehabilitation, University of South Florida, Tampa, USA
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24
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Arienti C, Lazzarini SG, Andrenelli E, Cordani C, Negrini F, Pollini E, Ceravolo MG. Rehabilitation and COVID-19: systematic review by Cochrane Rehabilitation. Eur J Phys Rehabil Med 2023; 59:800-818. [PMID: 38214047 DOI: 10.23736/s1973-9087.23.08331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Until the last update in February 2022, the Cochrane Rehabilitation COVID-19 Evidence-based Response (REH-COVER) action identified an increasing volume of evidence for the rehabilitation management of COVID-19. Therefore, our aim was to identify the best available evidence on the effectiveness of interventions for rehabilitation for COVID-19-related limitations of functioning of rehabilitation interest in adults with COVID-19 or post COVID-19 condition (PCC). EVIDENCE ACQUISITION We ran the searches on February 17th, 2023, in the following databases: PubMed, EMBASE, CENTRAL, CINHAL, and the Cochrane COVID-19 Study Register, applying a publication date restriction to retrieve only papers published in 2022. To retrieve papers published before 2022, we screened the reference lists of previous publications included in the REH-COVER action, covering papers from early 2020 to the end of 2022. This current review includes only randomised controlled trials and concludes the rapid living systematic reviews of the Cochrane Rehabilitation REH-COVER action. The risk of bias and certainty of evidence were evaluated in all studies using the Cochrane Risk of Bias tool and GRADE, respectively. We conducted a narrative synthesis of the evidence. PROSPERO registration number: CRD42022374244. EVIDENCE SYNTHESIS After duplicate removal, we identified 18,950 individual records and 53 RCTs met the inclusion criteria. Our findings suggest that the effect of breathing and strengthening exercise programs on dyspnea and physical exercise capacity compared to no treatment in non-severe COVID-19 patients is uncertain. Multicomponent telerehabilitation may slightly increase physical exercise capacity compared to educational intervention in adults with PCC. There is, however, uncertainty about its effect on lung function and physical exercise capacity when compared to no treatment. Finally, the effect of inspiratory muscle training on maximal inspiratory pressure compared to no treatment in adults with PCC is uncertain. CONCLUSIONS Interventions that are part of comprehensive pulmonary rehabilitation approaches may benefit dyspnea and exercise tolerance in adults with COVID-19 and PCC. The available evidence has several methodological limitations that limit the certainty of evidence and the clinical relevance of findings. Therefore, we cannot provide robust suggestions for practice. While high-quality RCTs are being conducted, clinicians should consider using high-quality evidence from other pulmonary conditions to rehabilitate patients with COVID-19 or PCC using context-specific interventions.
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Affiliation(s)
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesco Negrini
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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25
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Ceravolo MG, Anwar F, Andrenelli E, Udensi C, Qureshi J, Sivan M, Kiekens C, Zampolini M. Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2023; 59:789-799. [PMID: 38214046 DOI: 10.23736/s1973-9087.23.08315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician's professional practice for persons with COVID-19-related functioning limitations, to promote functional recovery and reduce activity limitations and/or participation restrictions. A systematic review of the scientific literature was performed from December 2019 to August 2022, followed by production of recommendations through 5 Delphi rounds, by consensus among the delegates of all European countries represented in the Union of European Medical Specialists PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The PRM physician's role for persons with COVID-19-related limitations of functioning is to develop, foster, and monitor the implementation of an individual rehabilitation project tailored to the patient's age, previous medical and functional status, current comorbidities and complications, activity limitations and participation restrictions and personal and environmental factors. This is done by applying the concept of a multi-specialty integrated service model with multi-professional/interdisciplinary teams, providing care at all stages of COVID-19 illness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section.
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Affiliation(s)
- Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
| | - Fahim Anwar
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy -
| | - Cynthia Udensi
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jawaria Qureshi
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary, University of Leeds, Leeds, UK
| | | | - Mauro Zampolini
- Department of Rehabilitation, Hospital of Foligno, USL Umbria2, Perugia, Italy
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26
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Sánchez-García JC, Reinoso-Cobo A, Piqueras-Sola B, Cortés-Martín J, Menor-Rodríguez MJ, Alabau-Dasi R, Rodríguez-Blanque R. Long COVID and Physical Therapy: A Systematic Review. Diseases 2023; 11:163. [PMID: 37987274 PMCID: PMC10660729 DOI: 10.3390/diseases11040163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
Prolonged COVID is a persistent condition following the initial COVID-19 infection, which is characterized by a variety of symptoms that may include fatigue, muscle pain, sleep disturbances, "brain fog", respiratory, cardiovascular, digestive, neurological and dermatological symptoms. Physical therapy has been identified as a crucial aspect of the management of patients with long COVID, as it can help improve symptoms and overall physical function. The investigation of long COVID poses significant challenges due to the diversity and variability of symptoms, lack of clear diagnostic criteria, and limited understanding of the underlying mechanisms. The aim of this study is to conduct a systematic review of studies conducted in patients with long COVID in conjunction with interventions targeting respiratory function, particularly involving physical activity. To this end, we conducted a systematic review to analyze studies conducted on treatment programs for long COVID based on some form of physical activity. The protocol of the review was registered in the PROSPERO website, and the databases PubMed, Scopus, CINAHL and WOS were searched. Of the 62 initial articles, six were included in the review. The results obtained have positive implications for the advancement of physical activity as a therapeutic intervention for individuals with long COVID-19 and the conceptualization of evidence-based treatment protocols. Statistically significant results have been observed in studies of at least 6 weeks duration, in which inspiratory muscle training exercises are proposed. Further research is needed to better understand long COVID and develop effective treatment strategies.
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Affiliation(s)
- Juan Carlos Sánchez-García
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Ampliación de Campus de Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (A.R.-C.); (R.A.-D.)
| | - Beatriz Piqueras-Sola
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - María José Menor-Rodríguez
- Área Sanitaria Santiago de Compostela-Barbanza, Subdirección de Humanización y Atención a la Ciudadanía, 15706 Santiago de Compostela, Spain;
| | - Raquel Alabau-Dasi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Ampliación de Campus de Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (A.R.-C.); (R.A.-D.)
| | - Raquel Rodríguez-Blanque
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- San Cecilio University Hospital, 18071 Granada, Spain
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27
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Luchian ML, Higny J, Benoit M, Robaye B, Berners Y, Henry JP, Colle B, Xhaët O, Blommaert D, Droogmans S, Motoc AI, Cosyns B, Gabriel L, Guedes A, Demeure F. Unmasking Pandemic Echoes: An In-Depth Review of Long COVID's Unabated Cardiovascular Consequences beyond 2020. Diagnostics (Basel) 2023; 13:3368. [PMID: 37958264 PMCID: PMC10647305 DOI: 10.3390/diagnostics13213368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
At the beginning of 2020, coronavirus disease 2019 (COVID-19) emerged as a new pandemic, leading to a worldwide health crisis and overwhelming healthcare systems due to high numbers of hospital admissions, insufficient resources, and a lack of standardized therapeutic protocols. Multiple genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected since its first public declaration in 2020, some of them being considered variants of concern (VOCs) corresponding to several pandemic waves. Nevertheless, a growing number of COVID-19 patients are continuously discharged from hospitals, remaining symptomatic even months after their first episode of COVID-19 infection. Long COVID-19 or 'post-acute COVID-19 syndrome' emerged as the new pandemic, being characterized by a high variability of clinical manifestations ranging from cardiorespiratory and neurological symptoms such as chest pain, exertional dyspnoea or cognitive disturbance to psychological disturbances, e.g., depression, anxiety or sleep disturbance with a crucial impact on patients' quality of life. Moreover, Long COVID is viewed as a new cardiovascular risk factor capable of modifying the trajectory of current and future cardiovascular diseases, altering the patients' prognosis. Therefore, in this review we address the current definitions of Long COVID and its pathophysiology, with a focus on cardiovascular manifestations. Furthermore, we aim to review the mechanisms of acute and chronic cardiac injury and the variety of cardiovascular sequelae observed in recovered COVID-19 patients, in addition to the potential role of Long COVID clinics in the medical management of this new condition. We will further address the role of future research for a better understanding of the actual impact of Long COVID and future therapeutic directions.
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Affiliation(s)
- Maria-Luiza Luchian
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Julien Higny
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Martin Benoit
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Benoit Robaye
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Yannick Berners
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Jean-Philippe Henry
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Benjamin Colle
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Olivier Xhaët
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Dominique Blommaert
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Steven Droogmans
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Andreea Iulia Motoc
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Laurence Gabriel
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Antoine Guedes
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Fabian Demeure
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
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Lewthwaite H, Byrne A, Brew B, Gibson PG. Treatable traits for long COVID. Respirology 2023; 28:1005-1022. [PMID: 37715729 DOI: 10.1111/resp.14596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Abstract
Long COVID, or post-acute COVID-19 sequelae, is experienced by an estimated one in eight adults following acute COVID-19. Long COVID is a new and complex chronic health condition that typically includes multiple symptoms that cross organ systems and fluctuate over time; a one-size-fits-all approach is, therefore, not likely to be appropriate nor relevant for long COVID treatment. 'Treatable Traits' is a personalized medicine approach, purpose-built to address the complexity and heterogeneity of complex chronic conditions. This comprehensive review aimed to understand how a treatable traits approach could be applied to long COVID, by first identifying the most prevalent long COVID treatable traits and then the available evidence for strategies to target these traits. An umbrella review of 22 systematic reviews identified 34 symptoms and complications common with long COVID, grouped into eight long COVID treatable trait clusters: neurological, chest, psychological, pain, fatigue, sleep impairment, functional impairment and other. A systematic review of randomized control trials identified 18 studies that explored different intervention approaches for long COVID prevention (k = 4) or management (k = 14). While a single study reported metformin as effective for long COVID prevention, the findings need to be replicated and consensus is required around how to define long COVID as a clinical trial endpoint. For long COVID management, current evidence supports exercise training or respiratory muscle training for long COVID treatable traits in the chest and functional limitation clusters. While there are studies exploring interventions targeting other long COVID treatable traits, further high-quality RCTs are needed, particularly targeting treatable traits in the clusters of fatigue, psychological, pain and sleep impairment.
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Affiliation(s)
- Hayley Lewthwaite
- Centre of Research Excellence Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Anthony Byrne
- Heart Lung Clinic, Department of Thoracic Medicine St Vincent's Hospital and Clinical School University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Bruce Brew
- Peter Duncan Neuroscience Research Unit, St. Vincent's Centre for Applied Medical Research, Darlinghurst, New South Wales, Australia
- Department of Neurology and Immunology, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Peter G Gibson
- Centre of Research Excellence Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Edward JA, Peruri A, Rudofker E, Shamapant N, Parker H, Cotter R, Sabin K, Lawley J, Cornwell WK. Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID. J Cardiopulm Rehabil Prev 2023; 43:400-406. [PMID: 37646620 DOI: 10.1097/hcr.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The post-acute sequalae of SARS-CoV-2, also known as "Long COVID," is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
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Affiliation(s)
- Justin A Edward
- Department of Medicine-Cardiology (Drs Edward, Rudofker, Shamapant, Parker, Cotter, and Cornwell and Ms Sabin) and Clinical Translational Research Center (Dr Cornwell), University of Colorado Anschutz Medical Campus, Aurora; Department of Medicine, Division of Cardiology, Parkview Medical Center, Pueblo, Colorado (Dr Peruri); and Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria (Dr Lawley)
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Perli VAS, Sordi AF, Lemos MM, Fernandes JSA, Capucho VBN, Silva BF, de Paula Ramos S, Valdés-Badilla P, Mota J, Branco BHM. Body composition and cardiorespiratory fitness of overweight COVID-19 survivors in different severity degrees: a cohort study. Sci Rep 2023; 13:17615. [PMID: 37848529 PMCID: PMC10582021 DOI: 10.1038/s41598-023-44738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023] Open
Abstract
COVID-19 sequelae are varied, and whether they are temporary or permanent is still unknown. Identifying these sequelae may guide therapeutic strategies to improve these individuals' recovery. This prospective cohort aimed to assess body composition, cardiopulmonary fitness, and long-term symptoms of overweight individuals affected by COVID-19. Participants (n = 90) were divided into three groups according to the severity of acute COVID-19: mild (no hospitalization), moderate (hospitalization, without oxygen support), and severe/critical cases (hospitalized in Intensive Care Unit). We assessed body composition with a tetrapolar multifrequency bioimpedance, hemodynamic variables (heart rate, blood pressure, and peripheral oxygen saturation-SpO2) at rest, and the Bruce test with direct gas exchange. Two assessments with a one-year interval were performed. The most prevalent long-term symptoms were memory deficit (66.7%), lack of concentration (51.7%), fatigue (65.6%), and dyspnea (40%). Bruce test presented a time effect with an increase in the distance walked after 1 year just for severe/critical group (p < 0.05). SpO2 was significantly lower in the severe/critical group up to 5 min after the Bruce test when compared to the mild group, and diastolic blood pressure at the end of the Bruce test was significantly higher in the severe/critical group when compared to mild group (p < 0.05; for all comparisons). A time effect was observed for body composition, with increased lean mass, skeletal muscle mass, fat-free mass, and lean mass just for the severe/critical group after 1 year (p < 0.05). Cardiopulmonary fitness parameters did not differ among the groups, except for respiratory quotient with higher values for the severe/critical group when compared to itself after 1 year. All COVID-19 patients might present long-term sequelae, regardless of the acute disease severity. Reassessing and identifying the most prevalent long-term sequelae are essential to perform more precise health promotion interventions.
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Affiliation(s)
| | | | - Maurício Medeiros Lemos
- University Cesumar, Maringa, Parana, Brazil
- Graduate Program in Health Promotion, University Cesumar, Maringa, Paraná, Brazil
| | | | | | | | | | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar, Chile
| | - Jorge Mota
- Laboratory for Integrative and Translational Research in Population Health (ITR), Research Center of Physical Activity, Health, and Leisure, Faculty of Sports, University of Porto, Porto, Portugal
| | - Braulio Henrique Magnani Branco
- University Cesumar, Maringa, Parana, Brazil.
- Graduate Program in Health Promotion, University Cesumar, Maringa, Paraná, Brazil.
- Laboratory for Integrative and Translational Research in Population Health (ITR), Research Center of Physical Activity, Health, and Leisure, Faculty of Sports, University of Porto, Porto, Portugal.
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Avenida Guedner, 1610, Maringá, Paraná, Brazil.
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Yang J, Lim KH, Lim KT, Woods JT, Mohabbat AB, Wahner-Roedler DL, Ganesh R, Bauer BA. Complementary and alternative medicine for long COVID: a systematic review of randomized controlled trials. Ther Adv Chronic Dis 2023; 14:20406223231204727. [PMID: 37841213 PMCID: PMC10571674 DOI: 10.1177/20406223231204727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Complementary and alternative medicine (CAM) interventions are growing in popularity as possible treatments for long COVID symptoms. However, comprehensive analysis of current evidence in this setting is still lacking. Objective This study aims to review existing published studies on the use of CAM interventions for patients experiencing long COVID through a systematic review. Design Systematic review of randomized controlled trials (RCTs). Methods A comprehensive electronic literature search was performed in multiple databases and clinical trial registries from September 2019 to January 2023. RCTs evaluating efficacy and safety of CAM for long COVID were included. Methodological quality of each included trial was appraised with the Cochrane 'risk of bias' tool. A qualitative analysis was conducted due to heterogeneity of included studies. Results A total of 14 RCTs with 1195 participants were included in this review. Study findings demonstrated that CAM interventions could benefit patients with long COVID, especially those suffering from neuropsychiatric disorders, olfactory dysfunction, cognitive impairment, fatigue, breathlessness, and mild-to-moderate lung fibrosis. The main interventions reported were self-administered transcutaneous auricular vagus nerve stimulation, neuro-meditation, dietary supplements, olfactory training, aromatherapy, inspiratory muscle training, concurrent training, and an online breathing and well-being program. Conclusion CAM interventions may be effective, safe, and acceptable to patients with symptoms of long COVID. However, the findings from this systematic review should be interpreted with caution due to various methodological limitations. More rigorous trials focused on CAM for long COVID are warranted in the future.
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Affiliation(s)
- Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kia Teng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Arya B. Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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del Corral T, Fabero-Garrido R, Plaza-Manzano G, Navarro-Santana MJ, Fernández-de-las-Peñas C, López-de-Uralde-Villanueva I. Minimal Clinically Important Differences in EQ-5D-5L Index and VAS after a Respiratory Muscle Training Program in Individuals Experiencing Long-Term Post-COVID-19 Symptoms. Biomedicines 2023; 11:2522. [PMID: 37760964 PMCID: PMC10526144 DOI: 10.3390/biomedicines11092522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
The primary aim of this study was to determine the minimal clinically important difference (MCID) for the EuroQol-5D questionnaire (EQ-5D-5L) index and visual analogic scale (VAS) in individuals experiencing long-term post-COVID-19 symptoms. In addition, it was pretended to determine which variable discriminates better and to compare changes between individuals classified by the MCID. DESIGN Secondary analysis of a randomized controlled trial involving 42 individuals who underwent an 8-week intervention in a respiratory muscle training program. RESULTS A change of at least 0.262 and 7.5 for the EQ-5D-5L index and VAS represented the MCID, respectively. Only the EQ-5D-5L VAS showed acceptable discrimination between individuals who were classified as "improved" and those classified as "stable/not improved" (area under the curve = 0.78), although with a low Youden index (Youden index, 0.39; sensitivity, 46.2%; specificity, 93.1%). Those individuals who exceeded the established MCID for EQ-5D-5L VAS had significantly greater improvements in inspiratory muscle function, exercise tolerance, and peripheral muscle strength compared to participants classified as "stable/not improved". CONCLUSIONS Only the EQ-5D-5L VAS, especially when MCID was exceeded, showed an acceptable discriminative ability to evaluate the efficacy of an intervention in individuals with long-term post-COVID-19 symptoms.
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Affiliation(s)
- Tamara del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (T.d.C.); (R.F.-G.); (M.J.N.-S.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Raúl Fabero-Garrido
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (T.d.C.); (R.F.-G.); (M.J.N.-S.); (I.L.-d.-U.-V.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (T.d.C.); (R.F.-G.); (M.J.N.-S.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (T.d.C.); (R.F.-G.); (M.J.N.-S.); (I.L.-d.-U.-V.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (T.d.C.); (R.F.-G.); (M.J.N.-S.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Pouliopoulou DV, Macdermid JC, Saunders E, Peters S, Brunton L, Miller E, Quinn KL, Pereira TV, Bobos P. Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post-COVID-19 Condition: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2333838. [PMID: 37725376 PMCID: PMC10509723 DOI: 10.1001/jamanetworkopen.2023.33838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023] Open
Abstract
Importance Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC. Objective To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC. Data Sources A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial. Study Selection This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers. Main Outcomes and Measures The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs. Results Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.
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Affiliation(s)
- Dimitra V. Pouliopoulou
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
| | - Joy C. Macdermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
| | - Emily Saunders
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Sue Peters
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Laura Brunton
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Erin Miller
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Kieran L. Quinn
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiago V. Pereira
- Health Technology Assessment Unit, Department of Pharmaceutical Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Pavlos Bobos
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
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Durstenfeld MS, Peluso MJ, Kaveti P, Hill C, Li D, Sander E, Swaminathan S, Arechiga VM, Lu S, Goldberg SA, Hoh R, Chenna A, Yee BC, Winslow JW, Petropoulos CJ, Kelly JD, Glidden DV, Henrich TJ, Martin JN, Lee YJ, Aras MA, Long CS, Grandis DJ, Deeks SG, Hsue PY. Reduced Exercise Capacity, Chronotropic Incompetence, and Early Systemic Inflammation in Cardiopulmonary Phenotype Long Coronavirus Disease 2019. J Infect Dis 2023; 228:542-554. [PMID: 37166076 PMCID: PMC10686699 DOI: 10.1093/infdis/jiad131] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Mechanisms underlying persistent cardiopulmonary symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (postacute sequelae of coronavirus disease 2019 [COVID-19; PASC] or "long COVID") remain unclear. This study sought to elucidate mechanisms of cardiopulmonary symptoms and reduced exercise capacity. METHODS We conducted cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring among adults >1 year after SARS-CoV-2 infection, compared those with and those without symptoms, and correlated findings with previously measured biomarkers. RESULTS Sixty participants (median age, 53 years; 42% female; 87% nonhospitalized; median 17.6 months after infection) were studied. At CPET, 18/37 (49%) with symptoms had reduced exercise capacity (<85% predicted), compared with 3/19 (16%) without symptoms (P = .02). The adjusted peak oxygen consumption (VO2) was 5.2 mL/kg/min lower (95% confidence interval, 2.1-8.3; P = .001) or 16.9% lower percent predicted (4.3%-29.6%; P = .02) among those with symptoms. Chronotropic incompetence was common. Inflammatory markers and antibody levels early in PASC were negatively correlated with peak VO2. Late-gadolinium enhancement on CMR and arrhythmias were absent. CONCLUSIONS Cardiopulmonary symptoms >1 year after COVID-19 were associated with reduced exercise capacity, which was associated with earlier inflammatory markers. Chronotropic incompetence may explain exercise intolerance among some with "long COVID."
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Affiliation(s)
- Matthew S Durstenfeld
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Cardiology, Zuckerberg San Francisco General, University of California, San Francisco, San Francisco, California, USA
| | - Michael J Peluso
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Punita Kaveti
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Cardiology, UCSF Health, San Francisco, California, USA
| | - Christopher Hill
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Danny Li
- Division of Cardiology, Zuckerberg San Francisco General, University of California, San Francisco, San Francisco, California, USA
| | - Erica Sander
- Division of Cardiology, UCSF Health, San Francisco, California, USA
| | - Shreya Swaminathan
- Division of Cardiology, Zuckerberg San Francisco General, University of California, San Francisco, San Francisco, California, USA
| | - Victor M Arechiga
- Division of Cardiology, Zuckerberg San Francisco General, University of California, San Francisco, San Francisco, California, USA
| | - Scott Lu
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Sarah A Goldberg
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca Hoh
- Division of Cardiology, Zuckerberg San Francisco General, University of California, San Francisco, San Francisco, California, USA
| | - Ahmed Chenna
- Monogram Biosciences, LabCorp, University of California, San Francisco, California, USA
| | - Brandon C Yee
- Monogram Biosciences, LabCorp, University of California, San Francisco, California, USA
| | - John W Winslow
- Monogram Biosciences, LabCorp, University of California, San Francisco, California, USA
| | | | - J Daniel Kelly
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Timothy J Henrich
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Yoo Jin Lee
- Cardiac and Pulmonary Imaging, Department of Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Mandar A Aras
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Cardiology, UCSF Health, San Francisco, California, USA
| | - Carlin S Long
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Cardiology, UCSF Health, San Francisco, California, USA
| | - Donald J Grandis
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Cardiology, UCSF Health, San Francisco, California, USA
| | - Steven G Deeks
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Priscilla Y Hsue
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Cardiology, Zuckerberg San Francisco General, University of California, San Francisco, San Francisco, California, USA
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Sordi AF, Lemos MM, de Souza Marques DC, Ryal JJ, Priscila de Paula Silva Lalucci M, Marques MG, Amaro Camilo ML, De Paula Ramos S, Franzói De Moraes SM, Valdés-Badilla P, Mota J, Magnani Branco BH. Effects of a multi-professional intervention on body composition, physical fitness and biochemical markers in overweight COVID-19 survivors: a clinical trial. Front Physiol 2023; 14:1219252. [PMID: 37700761 PMCID: PMC10494426 DOI: 10.3389/fphys.2023.1219252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction: The sequelae post-COVID can affect different systems. In this sense, considering the multi-factorial etiology of COVID-19, multi-professional interventions could be a relevant strategy for recovery health indicators. Objective: This study aimed to investigate the effects of multi-professional intervention on body composition, physical fitness, and biomarkers in overweight COVID-19 survivors with different symptomatology. Methodology: A non-randomized parallel group intervention included 69 volunteers (BMI ≥25 kg/m2), divided into three groups according to SARS CoV-2 symptomatology, but only 35 finished the longitudinal protocol [control group (n = 11); moderate group (n = 17) and severe group (n = 7)]. The groups were submitted to a multi-professional program (nutritional intervention, psychoeducation, and physical exercise intervention) for 8 weeks, and the volunteers underwent body composition assessments (primary outcome) and physical and biochemical tests (secondary outcome) in pre- and post-intervention. This study was registered on the Clinical Trials Registration Platform number: RBR-4mxg57b and with the local research ethics committee protocol under number: 4,546,726/2021. Results: After the 8-week multi-professional intervention, the following results were observed for the moderate COVID-19 group: improved dynamic strength of lower- and (p = 0.003), upper-limbs (p = 0.008), maximal isometric lumbar-traction strength (p = 0.04), flexibility (p = 0.0006), and albumin (p = 0.0005), as well as a reduction in the C reactive protein (CRP) (p = 0.003) and fasting glucose (p = 0.001); for the severe COVID-19 group: an improvement in dynamic lower-body strength (p = 0.001), higher values of albumin (p = 0.005) and HDL-c (p = 0.002), and lower values of CRP (p = 0.05), and for the control group: an improvement in sit-up repetitions (p = 0.008), and a reduction of CRP (p = 0.01), fasting glucose (p = 0.001) and total cholesterol (p = 0.04) were identified. All experimental groups reduced triglycerides after intervention (p < 0.05). Conclusion: Finally, 8 weeks of multiprofessional intervention can be an efficient tool for reversing the inflammatory process and promoting improvements in daily activities and quality of life, although it is believed that the severe COVID-19 group needs longer interventions to improve different health indicators. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-4mxg57b.
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Affiliation(s)
- Ana Flávia Sordi
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
| | - Maurício Medeiros Lemos
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
- Graduate Program in Health Promotion, Cesumar University, Maringá, Brazil
| | - Déborah Cristina de Souza Marques
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
- Graduate Program in Health Promotion, Cesumar University, Maringá, Brazil
| | - Joed Jacinto Ryal
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
- Graduate Program in Health Promotion, Cesumar University, Maringá, Brazil
| | - Marielle Priscila de Paula Silva Lalucci
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
- Graduate Program in Health Promotion, Cesumar University, Maringá, Brazil
| | - Marilene Guiraldi Marques
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
- Graduate Program in Health Promotion, Cesumar University, Maringá, Brazil
| | - Maria Luiza Amaro Camilo
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
| | | | | | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar, Chile
| | - Jorge Mota
- Laboratory for Integrative and Translational Research in Population Health (ITR), Research Centre of Physical Activity, Health, and Leisure, Faculty of Sports, University of Porto, Porto, Portugal
| | - Braulio Henrique Magnani Branco
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology and Innovation, Maringá, Brazil
- Graduate Program in Health Promotion, Cesumar University, Maringá, Brazil
- Laboratory for Integrative and Translational Research in Population Health (ITR), Research Centre of Physical Activity, Health, and Leisure, Faculty of Sports, University of Porto, Porto, Portugal
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Sick J, König D. Exercise Training in Non-Hospitalized Patients with Post-COVID-19 Syndrome-A Narrative Review. Healthcare (Basel) 2023; 11:2277. [PMID: 37628475 PMCID: PMC10454172 DOI: 10.3390/healthcare11162277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Post COVID-19 Syndrome (PCS) is the persistence of symptoms after an infection with SARS-CoV-2 in both hospitalized and non-hospitalized COVID-19 survivors. Exercise was proposed as a rehabilitation measure for PCS and early studies focused on patients post-hospital discharge. The objective of this review is to summarize the results of trials investigating exercise interventions in non-hospitalized subjects with PCS and propose practical recommendations concerning safe exercise programming. A literature search in the databases MEDLINE and Scopus was conducted until 26 July 2023 and resulted in seven studies that met the criteria. In total, 935 subjects with PCS were investigated. Exercise enhanced aerobic fitness and physical function and relieved symptoms of dyspnea, fatigue and depression. Participants reported lower Post COVID-19 Functional Status scores post-intervention. The exercise programs were well tolerated with no adverse events. To ensure safety, medical examinations should take place in advance and there should be a regular evaluation of the individual responses to the training. Caution is advised when working with patients suffering from post-exertional malaise or diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome. There is a growing need for additional randomized controlled trials to investigate the effectiveness and safety of exercise in individuals with PCS.
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Affiliation(s)
- Johanna Sick
- Department of Sport Science, Centre for Sports Science and University Sports, University of Vienna, 1150 Vienna, Austria;
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, 1090 Vienna, Austria
| | - Daniel König
- Department of Sport Science, Centre for Sports Science and University Sports, University of Vienna, 1150 Vienna, Austria;
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, 1090 Vienna, Austria
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Meléndez-Oliva E, Martínez-Pozas O, Cuenca-Zaldívar JN, Villafañe JH, Jiménez-Ortega L, Sánchez-Romero EA. Efficacy of Pulmonary Rehabilitation in Post-COVID-19: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:2213. [PMID: 37626710 PMCID: PMC10452542 DOI: 10.3390/biomedicines11082213] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis examines how pulmonary rehabilitation impacts in patients suffering from subacute and long COVID-19 infections, gauging enhancements in of dyspnea, physical function, quality of life, psychological state (anxiety and depression), and fatigue. METHODS Three electronic databases (PubMed, Web of Science, Cochrane Library) were systematically searched for full-text articles published from inception to January 2023. Randomized, quasi-experimental, and observational studies were included, with adults diagnosed with subacute or long COVID-19 who received pulmonary rehabilitation as intervention. Outcomes related to dyspnea, physical function, quality of life, fatigue, and psychological status were included. Risk of bias was assessed with Cochrane Risk of Bias Tool for Randomized Controlled Trials and Risk of bias in non-randomized studies of intervention. The review was registered before starting in PROSPERO (CRD: 42022373075). RESULTS Thirty-four studies were included, involving 1970 patients with subacute and long COVID-19. The meta-analysis demonstrated moderate to large effects on dyspnea, physical function, quality of life, and depressive symptoms compared to usual care intervention. No significant differences were found in fatigue compared to usual care, nor in anxiety levels after pulmonary rehabilitation intervention. CONCLUSIONS Pulmonary rehabilitation has the potential to improve health outcomes in patients with subacute and long COVID-19. However, due to the high risk of bias of included studies, conclusions should be taken with caution.
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Affiliation(s)
- Erika Meléndez-Oliva
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Valencia, Pg. de l’Albereda, 7, 46010 Valencia, Spain;
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
| | - Oliver Martínez-Pozas
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Juan Nicolás Cuenca-Zaldívar
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Grupo de Investigación en Fisioterapia y Dolor, Departamento de Enfermería y Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain
- Physical Therapy Unit, Primary Health Care Center “El Abajón”, 28231 Madrid, Spain
| | | | - Laura Jiménez-Ortega
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain;
- Center of Human Evolution and Behavior, Carlos III Health Institute, Complutense University of Madrid, 28040 Madrid, Spain
| | - Eleuterio A. Sánchez-Romero
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
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Chen Y, Liu X, Tong Z. Can inspiratory muscle training benefit patients with COVID-19? A systematic review and meta-analysis. J Med Virol 2023; 95:e28956. [PMID: 37503550 DOI: 10.1002/jmv.28956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
The possible benefits of inspiratory muscle training (IMT) on mechanical and clinical outcomes in patients with Coronavirus disease-2019 (COVID-19) remain controversial. We conducted a meta-analysis to evaluate the effect of IMT in the rehabilitation strategy of patients with COVID-19. The Pubmed, Embase, Web of Science (WOS), and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify trials evaluating the efficacy of IMT in the treatment of patients with COVID-19. The primary outcome included change from baseline of VO2 max, maximal inspiratory pressure (PImax), 6-min walk test(6MWT), forced expiratory volume in the first second predicted (FEV1%pred), and quality of life (QOL). Six studies with 349 participants were analyzed. Significant improvements were found in change from baseline of VO2 max (MD: 4.54, 95% confidence interval [CI]: 1.79-7.30, Z = 3. 32, I2 = 0, p = 0.001), PImax (MD: 21.43, 95% CI: 1.33-41.52, Z = 2.09, I2 = 90%, p = 0.04), 6MWD (MD: 40.13, 95% CI: 24.92-55.35, Z = 5.17, I2 = 0, p < 0.00001) and FEV1%pred (MD: 8.73, 95% CI 3.07-14.39, Z = 3.02, p = 0.002) while no statistical improvements were found in QOL (SMD: 0.70, 95% CI: 0.37-1.03, Z = 4.15, I2 = 89% p = 0.32) between IMT group and control group. The application of IMT might elicit mechanical and clinical improvement in patients with COVID-19. IMT could be recommended as an effective strategy of pulmonary rehabilitation for COVID-19. However, the proper timing, optimal duration, as well as appropriate frequency and intensity of IMT remain uncertain and further studies are needed.
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Affiliation(s)
- Yusha Chen
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuefeng Liu
- Departments of Pathology, Urology, and Radiation Oncology, College of Medicine, OSU Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Feter N, Caputo EL, Delpino FM, Leite JS, da Silva LS, de Almeida Paz I, Santos Rocha JQ, Vieira YP, Schröeder N, da Silva CN, Baptista Gonçalves JC, da Costa Pereira H, Barbosa TA, Cassuriaga J, da Silva MC, Reichert FF, Rombaldi AJ. Physical activity and long COVID: findings from the Prospective Study About Mental and Physical Health in Adults cohort. Public Health 2023; 220:148-154. [PMID: 37320945 DOI: 10.1016/j.puhe.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The study investigated the longitudinal association between physical activity and the risk of long COVID in patients who recovered from COVID-19 infection. STUDY DESIGN We analyzed longitudinal data of the Prospective Study About Mental and Physical Health cohort, a prospective cohort study with adults living in Southern Brazil. METHODS Participants responded to an online, self-administered questionnaire in June 2020 (wave 1) and June 2022 (wave 4). Only participants who self-reported a positive test for COVID-19 were included. Physical activity was assessed before (wave 1, retrospectively) and during the pandemic (wave 1). Long COVID was assessed in wave 4 and defined as any post-COVID-19 symptoms that persisted for at least 3 months after infection. RESULTS A total of 237 participants (75.1% women; mean age [standard deviation]: 37.1 [12.3]) were included in this study. The prevalence of physical inactivity in baseline was 71.7%, whereas 76.4% were classified with long COVID in wave 4. In the multivariate analysis, physical activity during the pandemic was associated with a reduced likelihood of long COVID (prevalence ratio [PR]: 0.83; 95% confidence interval [CI]: 0.69-0.99) and a reduced duration of long COVID symptoms (odds ratio: 0.44; 95% CI: 0.26-0.75). Participants who remained physically active from before to during the pandemic were less likely to report long COVID (PR: 0.74; 95% CI: 0.58-0.95), fatigue (PR: 0.49; 95% CI: 0.32-0.76), neurological complications (PR: 0.47; 95% CI: 0.27-0.80), cough (PR: 0.40; 95% CI: 0.22-0.71), and loss of sense of smell or taste (PR: 0.43; 95% CI: 0.21-0.87) as symptom-specific long COVID. CONCLUSION Physical activity practice was associated with reduced risk of long COVID in adults.
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Affiliation(s)
- N Feter
- Postgraduate Program in Epidemiology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - E L Caputo
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - F M Delpino
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - J S Leite
- Postgraduate Program in Health Sciences, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - L S da Silva
- Postgraduate Program in Epidemiology, Medicine School, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - I de Almeida Paz
- Postgraduate Program in Human Movement Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - J Q Santos Rocha
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Y P Vieira
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - N Schröeder
- Food, Nutrition and Health Postgraduate Program, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - C N da Silva
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - J C Baptista Gonçalves
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - H da Costa Pereira
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - T A Barbosa
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - J Cassuriaga
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - M C da Silva
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - F F Reichert
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - A J Rombaldi
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Güneş M, Yana M, Güçlü MB. Physical activity levels respiratory and peripheral muscle strength and pulmonary function in young post-COVID-19 patients : A cross-sectional study. Wien Klin Wochenschr 2023; 135:251-259. [PMID: 37115337 PMCID: PMC10141881 DOI: 10.1007/s00508-023-02204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) causes permanent problems, even mild severity. The long-term consequences of COVID-19 are still unknown. This study aimed to investigate physical activity levels, respiratory and peripheral muscle strength, and pulmonary function in the long term in young adult COVID-19 patients who recovered from mild disease. METHODS This cross-sectional study was carried out at least 6 months after the COVID-19 diagnosis, 54 patients with COVID-19 (median age: 20 years) and 46 controls (median age: 21 years) were compared. Functional status (post-COVID-19 functional status scale), respiratory (maximum inspiratory and expiratory pressures (MIP, MEP)) and peripheral muscle strength (dynamometer), pulmonary function (Spirometry), dyspnea and fatigue (modified Borg scale), and physical activity levels (International Physical Activity Questionnaire) were evaluated. CLINICALTRIAL NUMBER NCT05381714. RESULTS Patients with COVID-19 measured and percent predicted MIP and MEP were statistically decreased compared with the controls (p < 0.05). Shoulder abductors muscle strength (p < 0.001) and the number of individuals with low physical activity levels were significantly higher in patients compared with controls (p = 0.048). Pulmonary function, quadriceps muscle strength, exertional dyspnea, and fatigue scores were similar in groups (p > 0.05). CONCLUSION Respiratory and peripheral muscle strength and physical activity levels are adversely affected in patients with COVID-19, even though the patients were mildly affected in the long term. Also, symptoms such as dyspnea and fatigue may persist. Therefore, these parameters should be evaluated in the long term, even in young adults who are mildly affected by COVID-19.
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Affiliation(s)
- Musa Güneş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karabuk University, Karabuk, Turkey.
- Iron Steel Campus, Faculty of Health Sciences, Karabuk University, City Centre/Karabük, Turkey.
| | - Metehan Yana
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karabuk University, Karabuk, Turkey
| | - Meral Boşnak Güçlü
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Durstenfeld MS, Peluso MJ, Kaveti P, Hill C, Li D, Sander E, Swaminathan S, Arechiga VM, Lu S, Goldberg SA, Hoh R, Chenna A, Yee BC, Winslow JW, Petropoulos CJ, Kelly JD, Glidden DV, Henrich TJ, Martin JN, Lee YJ, Aras MA, Long CS, Grandis DJ, Deeks SG, Hsue PY. Reduced exercise capacity, chronotropic incompetence, and early systemic inflammation in cardiopulmonary phenotype Long COVID. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2022.05.17.22275235. [PMID: 35677073 PMCID: PMC9176659 DOI: 10.1101/2022.05.17.22275235] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Mechanisms underlying persistent cardiopulmonary symptoms following SARS-CoV-2 infection (post-acute sequelae of COVID-19 "PASC" or "Long COVID") remain unclear. This study sought to elucidate mechanisms of cardiopulmonary symptoms and reduced exercise capacity using advanced cardiac testing. METHODS We performed cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring among adults > 1 year after confirmed SARS-CoV-2 infection in Long-Term Impact of Infection with Novel Coronavirus cohort (LIINC; substudy of NCT04362150 ). Adults who completed a research echocardiogram (at a median 6 months after SARS-CoV-2 infection) without evidence of heart failure or pulmonary hypertension were asked to complete additional cardiopulmonary testing approximately 1 year later. Although participants were recruited as a prospective cohort, to account for selection bias, the primary analyses were as a case-control study comparing those with and without persistent cardiopulmonary symptoms. We also correlated findings with previously measured biomarkers. We used logistic regression and linear regression models to adjust for potential confounders including age, sex, body mass index, time since SARS-CoV-2 infection, and hospitalization for acute SARS-CoV-2 infection, with sensitivity analyses adjusting for medical history. RESULTS Sixty participants (unselected for symptoms, median age 53, 42% female, 87% non- hospitalized) were studied at median 17.6 months following SARS-CoV-2 infection. On maximal CPET, 18/37 (49%) with symptoms had reduced exercise capacity (peak VO 2 <85% predicted) compared to 3/19 (16%) without symptoms (p=0.02). The adjusted peak VO 2 was 5.2 ml/kg/min (95%CI 2.1-8.3; p=0.001) or 16.9% lower actual compared to predicted (95%CI 4.3- 29.6; p=0.02) among those with symptoms compared to those without symptoms. Chronotropic incompetence was present among 12/21 (57%) with reduced VO 2 including 11/37 (30%) with symptoms and 1/19 (5%) without (p=0.04). Inflammatory markers (hsCRP, IL-6, TNF-α) and SARS-CoV-2 antibody levels measured early in PASC were negatively correlated with peak VO 2 more than 1 year later. Late-gadolinium enhancement on CMR and arrhythmias on ambulatory monitoring were not present. CONCLUSIONS We found evidence of objectively reduced exercise capacity among those with cardiopulmonary symptoms more than 1 year following COVID-19, which was associated with elevated inflammatory markers early in PASC. Chronotropic incompetence may explain exercise intolerance among some with cardiopulmonary phenotype Long COVID. Key Points Long COVID symptoms were associated with reduced exercise capacity on cardiopulmonary exercise testing more than 1 year after SARS-CoV-2 infection. The most common abnormal finding was chronotropic incompetence. Reduced exercise capacity was associated with early elevations in inflammatory markers.
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42
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Ramírez-Vélez R, García-Azlonso N, Oteiza J, Izquierdo M. [Cardiopulmonary exercise test in patients with post SARS-CoV-2 sequelae: need to create a multicenter working group. Response]. Rev Esp Cardiol 2023; 76:489-490. [PMID: 36743296 PMCID: PMC9882951 DOI: 10.1016/j.recesp.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Indexed: 01/29/2023]
Affiliation(s)
- Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, España,Autor para correspondencia:
| | - Nora García-Azlonso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, España
| | - Julio Oteiza
- Servicio de Medicina Interna, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, España
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, España
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